Sunday, July 29, 2018

Unusual sensory responses (i.e., sensory over-responsivity, sensory
under-responsivity, and sensory seeking) are relatively common in autism (ASD).
While no single type of sensory problem is
consistently associated with ASD, one of the most commonly
reported challenges for people with autism spectrum conditions is
hypersensitivity to noise. Many of the daily sounds
that other people take for granted can be very intrusive and painful to children and adults on the spectrum. This article from Friendship Circle lists the types of noise sensitivity
and offers some tips on how to help a highly sensitive person cope with everyday noisy situations.

1.
Know the types of sensitivity

There are several different types of noise sensitivity, and
there are different treatments for each type. Consult with an audiologist to
pinpoint which type of sensitivity is affecting your quality of life. These are
the 5 most common types of sensitivities, but keep in mind that a person may be
affected by more than one issue. For example, my son has hyperacusis in
addition to phobias of specific sounds.

Hyperacusis is
an intolerance of everyday environmental sounds and is often associated
with tinnitus, a ringing in the ears.

Hypersensitive
hearing of specific frequencies is often
(but not always) associated with autism. A person is able to tolerate most
sounds at normal levels, but certain frequencies are intolerable,
especially above 70 decibels. For example, a person may have no difficulty
being near a noisy dishwasher, but the higher frequency and higher decibel
level of the vacuum cleaner will be painful.

Recruitment is
directly related to sensorineural hearing loss. It is defined as an
atypical growth in the perception of loudness. Hair cells in the inner ear
typically “translate” sound waves into nerve signals. Damaged or dead hair
cells cannot perceive sound, but at a certain decibel level, surrounding
healthy hair cells are “recruited” to transmit, and the person experiences
a sudden sharp increase in sound perception that can be shocking and
painful.

Phonophobia (also
called ligyrophobia or sonophobia) is a persistent and unusual fear of
sound, either a specific sound such as an alarm or general environmental
sounds. People with phonophobia fear the possibility of being exposed to
sounds, especially loud sounds, in present and future situations, and
sometimes become homebound due to this anxiety.

Misophonia is
an emotional reaction, most often anger or rage, to specific sounds. The trigger
is usually a relatively soft sound related to eating or breathing and may
be connected to only one or a few people who are emotionally close to the
affected person. For example, my friend Lisa’s son Nate becomes angry and
runs out of the dining room because his father makes sounds while chewing
food, but Nate does not become angry when his mother and sister make
similar sounds.

2.
Provide relief

Headphones and earplugs offer instant comfort and
relief. Noise-canceling headphones are the most effective, because they replace
irritating environmental noise by producing calming white noise. Earplugs are
usually made of either foam or wax, and it is worth trying both types to
determine which is more comfortable.

However, most audiologists, physicians, therapists and
educators recommend against frequent use of headphones and earplugs, because a
person can quickly become dependent on them. In the long run, blocking out
noise can reduce coping skills and increase social withdrawal.

3.
Identify safe environments

One of the first steps that I took for my son was to make a
list of his “safe” places and increase his participation there. Depending on an
individual’s needs, this could mean:

volunteering
at the library

attending
library storytime

taking
a walk in a nature area every day

visiting
a park that is near a railroad crossing or helicopter landing pad

attending
services, prayers or social events at the Shul more often

4.
Allow control over some types of noise

At its heart, anxiety is a fear of being unable to control
reactions and situations. When my son had a phobia of bells, I gave him several
different types of bells to handle and experiment with at home. When we saw
bells at customer service desks or in other public places, I allowed him to
ring the bell. He gradually became comfortable with the sounds, and he even
began identifying speaker systems, alarm systems and other sources of sounds
everywhere we went.

5.
Allow distractions

When my husband and I took a Lamaze childbirth class many
years ago, we learned about the power of distraction in pain management. By
giving a person something like an iPad to focus on or an unusual privilege such
as bringing along a favorite toy from home, it becomes possible to direct
attention away from the offending noise.

Wednesday, July 11, 2018

Impairment in social communication and interaction is a core
feature of autism spectrum disorder (ASD). Social skills deficits include
difficulties with initiating interactions, maintaining reciprocity, taking
another person’s perspective, and inferring the interests of others. Social
relationship skills are critical to successful social, emotional, and cognitive
development and to long-term outcomes for students. Research evidence suggests
that when appropriately planned and systematically delivered, social skills
instruction has the potential to produce positive effects in the social
interactions of children with ASD. Both the National Professional Development
Center (NAC) and the National Autism Center (NAC) have identified social skills
training/instruction as an evidence-based intervention and
practice.

Executive Function

Executive
function (EF) is a broad term used to describe the higher-order cognitive
processes such as response initiation and selection, working memory, planning
and strategy formation, cognitive flexibility, inhibition of response,
self-monitoring and self-regulation. EF
skills allow us to plan and organize activities, sustain attention, persist to
complete a task, and manage our emotions and monitor our thoughts in order to
work more efficiently and effectively. Executive function and
self-regulation (EF/SR) problems have been demonstrated consistently in
school-age children and adolescents on the autism spectrum. Research suggests
that operations and activities that require mental flexibility, including
shifting of cognitive set and shifting of attention focus are impaired in
children and youth with autism. This includes difficulty directing,
controlling, inhibiting, maintaining, and generalizing behaviors required for
adjustment both in and outside of the classroom without external support and
structure from others. EF/SR skills have been linked to many important aspects
of child and adolescent functioning, such as academic achievement,
self-regulated learning, social-emotional development, physical well-being, and
behavioral problems. Research shows that children with strong EF/SR skills are
better prepared for school and have more positive social, adaptive, and
academic outcomes.

Research

A study published in the open access journal Autism
Research and Treatment examined potential changes in executive
function performance associated with participation in the Social Competence
Intervention (SCI) program, a short-term intervention designed to improve
social skills in adolescents with ASD. The Social Competence
Intervention-Adolescent (SCI-A) is based on cognitive-behavioral intervention
and applied behavior analysis and targets EF, theory of mind (ToM), and emotion
recognition as key constructs in addressing social skills impairments.

Behavioral performance measures were used to evaluate potential
intervention-related changes in executive function processes (i.e., working
memory, inhibitory control, and cognitive flexibility) in a sample of 22
adolescents with ASD both before and after intervention. For comparison
purposes, a demographically matched sample of 14 individuals without ASD was
assessed at the same time intervals. Intervention-related improvements were
observed on the working memory task, with gains evident in spatial working
memory and, to a somewhat lesser degree, verbal working memory. The finding of
improved working memory performance for the intervention group is consistent
with research suggesting that working memory represents an aspect of cognition
that may be malleable and responsive to intervention.

Additional research is needed to evaluate to what extent the
presently observed gains in EF performance may translate to other age ranges,
levels of symptom severity, and other social skills interventions. Further
research is also required to examine whether the presence/absence of comorbid
ADHD symptomatology may influence the effectiveness of interventions for
improving not only social skills but also underlying core EF processes such as
cognitive flexibility and working memory.

Implications

Previous research indicates that EF represents an area of weakness
for individuals with ASD even after accounting for comorbid conditions such as
ADHD. Reviews of the existing literature suggest that cognitive flexibility,
working memory, and inhibitory control are often impaired in autistic individuals. Each of these EF component processes play an important role in the
acquisition of knowledge and social skills; the better children are at focusing
and refocusing their attention, holding information in mind and manipulating it
(i.e., working memory), resisting distraction, and adapting flexibly to change,
the more positive the social, adaptive, and academic outcomes. The
aforementioned research findings contribute to the growing evidence that
children with autism who participate in social skills interventions that integrate
EF skills such as working memory, cognitive flexibility, emotional recognition,
and self-regulation experience not only an improvement in social competence,
but also underlying core neurocognitive EF processes. Executive dysfunction
places a child at-risk and is likely to have an adverse impact on many areas of
everyday life and affect adaptability in several domains (personal, social and communication). Systematic
social skills instruction that incorporates EF process components in program
delivery can help reduce the risk for negative outcomes for children on the
autism spectrum. Likewise, an assessment of EF skills can add important
information about the child’s strengths and weaknesses and inform
intervention/treatment planning. Best practice guidelines for assessment and
intervention are available from A Best Practice Guide to Assessment and Intervention for
Autism Spectrum Disorder in Schools (2nd Edition).

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